Healthcare Provider Details

I. General information

NPI: 1548173420
Provider Name (Legal Business Name): HAYLEE LYN PETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 HOLDEN BLVD
FAIRFIELD OH
45014-2100
US

IV. Provider business mailing address

8809B CINCINNATI DAYTON RD
WEST CHESTER OH
45069-3134
US

V. Phone/Fax

Practice location:
  • Phone: 513-942-2999
  • Fax:
Mailing address:
  • Phone: 513-360-8205
  • Fax: 513-620-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: